Resistance via mutations of the DNA pol gene can result in:
Impairment of NRTI incorporation into DNA
Removal of NRTI from the terminated DNA chain
Mutants that arise during combination therapy are cross-resistant to all NRTIs in clinical use

NNRTIs mechanism?

Bind to a site different from NRTIs
Don’t require phosphorylation to be active and don’t compete with nucleoside triphosphates
Bind to a hydrophobic subdomain near the active site of HIV-RT producing allosteric inhibition, enzyme can no longer bind normal substrate

NNRTIs toxicity?

relatively low, contraindicated in pregnancy

NNRTI drug interactions?

Nevaripine and efavirenz both induce and are metabolized by CYP3A4
Delavirdine is metabolized by and inhibits CYP3A4

Nelfinivir and saquinavir are well-tolerated rotinarvir is poorly tolerated at full dose

Drug interactions of PIs?

Drug interactions drugs that inhibit cytochrome P-450 CYP3A4, increase plasma concentration of PI toxicity
All Pis are substrates and inhibitors of CYP3A4. rotinavir is the most potent and saquinivir the least potent inhibitor.

what is enfurivitide?

Peptide that interferes with virus cell interaction and blocks viral fusion with the CD4 cell membrane